Endometrial cancer (EC) remains the most common gynecologic malignancy in the United
States. It is expected to become more common as the prevalence of obesity, one of
the most common risk factors for EC, increases worldwide. The 2 main histologic subcategories
of EC, endometrioid and nonendometrioid EC, show unique molecular aberrations and
are responsible for markedly disparate clinical behaviors. The primary treatment of
EC is surgery, ie, hysterectomy, removal of the adnexa, and pelvic and para-aortic
lymphadenectomy, either via laparotomy or endoscopic techniques. Adjuvant therapy
is necessary for patients at high risk of recurrence and consists of vaginal brachytherapy,
teletherapy, systemic chemotherapy, or some combination thereof. Multi-institutional
trials are in progress in this country and in Europe to better define optimal adjuvant
treatment for subsets of patients, as well as the role of surgical staging in reducing
both overuse and underuse of radiation therapy. Hormonal therapy is an option for
some young women with EC who wish to preserve fertility. This review summarizes the
diagnosis and management of EC and discusses current controversies and upcoming investigations
pertaining to EC staging and adjuvant treatment.
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